BACKGROUND: The aim of this review was to systematically assess the current evidence available regarding knee instability after TKA to identify time to failure between primary and revision TKA. In addition, we considered the patient, surgical and implant characteristics of primary TKA patients revised for knee instability, and investigated methods used for knee instability diagnosis. METHODS: A systematic search of six databases and the unpublished literature was performed. Studies referring to instability in post-operative primary TKA patients, reporting on revision TKA due to instability, and published or available between 2005 to 30-Mar-2015 were eligible for inclusion. Quantitative data for continuous variables were pooled in statistical meta-analyses. RESULTS: A total of 1841 unique studies were identified, 42 of which met the selection criteria and a total of 22 studies included in the review. Time to failure between primary and revision TKA was 44.7months (95% CI [33.8, 55.7]), and the weighted mean age at time of revision surgery was 67.6years (95% CI [65.38, 69.75]). A gender distribution was identified, with approximately 16.4% more females revised for instability, however this was unable to be corrected for the baseline population. The majority of studies used a combination of radiographic and clinical testing to diagnose knee instability. CONCLUSION: Research on knee instability following primary TKA reported early failure and subsequent revision knee surgery. The need for revision due to instability was frequently reported in a younger patient cohort and most commonly in female TKA patients. Early revision at a younger age highlights the severe implications of an unstable knee.